Outcome after esophagectomy for cancer better at high-volume hospitals

Last Modified: November 1, 2001

Last Updated: 2001-02-02 17:00:55 EST (Reuters Health) - Similar to results seen with other complex procedures, clinical outcomes of esophagectomy for cancer are better at centers that handle a high volume of esophagectomies, according to the findings of a study presented at the 37th Annual Meeting of The Society of Thoracic Surgeons.

In a study using data from the Massachusetts Health Data Consortium, Dr. Cameron D. Wright and colleagues from Massachusetts General Hospital in Boston compared the clinical outcomes of esophagectomy at centers that perform six or more esophagectomies each year (high volume) with centers that perform fewer than six per year (low volume).

"Mortality in the low-volume providers was 9.2% and in the high-volume providers it was 2.5%," Dr. Wright told Reuters Health. Multivariate and cluster analysis revealed that "the odds ratio for death in a low-volume hospital in Massachusetts is 4.3," he stated. "So there is a 400% increase in mortality if you have your esophagectomy at a low-volume hospital."

High-volume hospitals showed a trend toward shorter total lengths of stay and shorter ICU lengths of stay compared with low-volume hospitals, Dr. Wright noted. In addition, "significantly more patients were discharged to home rather than to a rehab facility at high-volume hospitals," he said.

Dr. Wright believes that the success at high-volume hospitals results from a combination of surgeon-specific and care team factors. Dr. Wright stated that similar studies involving pancreatic cancer have shown that high-volume surgeons do equally well in high- or low-volume hospitals, but low-volume surgeons tended to do better in high-volume hospitals.

When asked if surgeons at low-volume hospitals should be doing esophagectomies, Dr. Wright commented that "it is hard for me to say that an individual surgeon with good results in the past should not be doing it....[but] from an insurance company and Medicare perspective, it makes sense to me to refer complex cases to where you know there is a track record."